Opioid overdose

Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Full text  Abstract

Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Full text  Abstract

Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Full text

Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Full text  Abstract

Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Full text  Abstract

1. United States Drug Enforcement Administration. Synthetic opioids. Dec 2024 [internet publication].Full text

2. Blundell M, Gill R, Thanacoody R, et al. Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department. Emerg Med J. 2024 Jun 20;41(7):440-5. Abstract

3. World Health Organization. Opioid overdose. 2023 [internet publication].Full text

4. Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2023 registrations. Oct 2024 [internet publication].Full text

5. Centers for Disease Control and Prevention. ​National center for health statistics: U.S. overdose deaths decrease almost 27% in 2024. May 2025 [internet publication].Full text

6. Zawilska JB, Adamowicz P, Kurpeta M, et al. Non-fentanyl new synthetic opioids - an update. Forensic Sci Int. 2023 Aug;349:111775. Abstract

7. Seth P, Scholl L, Rudd RA, et al. Overdose deaths involving opioids, cocaine, and psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):349-58.Full text  Abstract

8. National Institute on Drug Abuse. Drug overdose deaths: facts and figures. Aug 2024 [internet publication].Full text

9. Centers for Disease Control and Prevention. National center for health statistics: provisional drug overdose death counts for specific drugs. Jan 2025 [internet publication].Full text

10. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): detection of illegally manufactured fentanyls and carfentanil in drug overdose deaths - United States, 2021-2024. Dec 2024 [internet publication].Full text

11. Centers for Disease Control and Prevention. Rising numbers of deaths involving fentanyl and fentanyl analogs, including carfentanil, and increased usage and mixing with non-opioids. HAN no. 413. July 2018 [internet publication].Full text

12. Drug Enforcement Administration. (U) Deadly contaminated cocaine widespread in Florida. Feb 2018 [internet publication].Full text

13. Friedman J, Shover CL. Charting the fourth wave: geographic, temporal, race/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010-2021. Addiction. 2023 Dec;118(12):2477-85.Full text  Abstract

14. Kariisa M, Patel P, Smith H, et al. Notes from the Field: xylazine detection and involvement in drug overdose deaths - United States, 2019. MMWR Morb Mortal Wkly Rep. 2021 Sep 17;70(37):1300-2.Full text  Abstract

15. U.S. Department of Justice; Drug Enforcement Administration. ​The growing threat of xylazine and its mixture with illicit drugs. Oct 2022 [internet publication].Full text

16. Palamar JJ, Krotulski AJ. Medetomidine infiltrates the US illicit opioid market. JAMA. 2024 Nov 5;332(17):1425-6.

17. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): overdoses involving medetomidine mixed with opioids - Chicago, Illinois, May 2024. May 2025 [internet publication].Full text

18. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): illicitly manufactured fentanyl-involved overdose deaths with detected xylazine - United States, January 2019-June 2022. Jun 2023 [internet publication].Full text

19. Wise J. Nitazenes: toxicologists warn of rise in overdoses linked to class of synthetic opioids. BMJ. 2024 Nov 8;387:q2465.

20. Montanari E, Madeo G, Pichini S, et al. Acute intoxications and fatalities associated with benzimidazole opioid (nitazene analog) use: a systematic review. Ther Drug Monit. 2022 Aug 1;44(4):494-510. Abstract

21. Office for Health Improvement and Disparities. Research and analysis: ​deaths linked to potent synthetic opioids. Oct 2024 [internet publication].Full text

22. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison - a high risk of death for former inmates. N Engl J Med. 2007 Jan 11;356(2):157-65. Abstract

23. James A, Williams J. Basic opioid pharmacology - an update. Br J Pain. 2020 May;14(2):115-21.Full text  Abstract

24. Hayashi T, Su T. The sigma receptor: evolution of the concept in neuropsychopharmacology. Curr Neuropharmacol. 2005 Oct;3(4):267-80.Full text  Abstract

25. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015 Feb 17;162(4):276-86. Abstract

26. Wang L, Hong PJ, Jiang W, et al. Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies. CMAJ. 2023 Oct 23;195(41):E1399-411.Full text  Abstract

27. Haffajee RL, Cherney S, Smart R. Legal requirements and recommendations to prescribe naloxone. Drug Alcohol Depend. 2020 Apr 1;209:107896.Full text  Abstract

28. Anoro M, Ilundain E, Rodriguez R, et al. Factors related to experiencing respiratory failure in cases of opiate overdose for which care was provided in an open setting. Barcelona, Spain. Rev Esp Salud Publica. Sep-Oct 2004;78(5):601-8.Full text  Abstract

29. World Health ​Organization. Community management of opioid overdose. 2014 [internet publication].Full text

30. Chang AK, Bijur PE, Esses D, et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. JAMA. 2017 Nov 7;318(17):1661-7. Abstract

31. Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Full text  Abstract

32. Osteen JD, Immani S, Tapley TL, et al. Pharmacology and mechanism of action of suzetrigine, a potent and selective Na(V)1.8 pain signal inhibitor for the treatment of moderate to severe pain. Pain Ther. 2025 Apr;14(2):655-74.Full text  Abstract

33. Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid overdose prevention toolkit. June 2018 [internet publication].Full text

34. Centers for Disease Control and Prevention; National Center for Injury Prevention and Control. Leveraging prescription drug monitoring program (PDMP) data in overdose prevention and response. Mar 2021 [internet publication].Full text

35. Maxwell S, Bigg D, Stanczykiewicz K, et al. Prescribing naloxone to actively injecting heroin users: a program to reduce heroin overdose deaths. J Addict Dis. 2006;25(3):89-96. Abstract

36. American Academy of Addiction Psychiatry. ​SAMHSA releases substance use disorder treatment month toolkit. Dec 2024 [internet publication].Full text

37. Centers for Disease Control and Prevention. Overdose prevention: preventing opioid overdose. May 2024 [internet publication].Full text

38. US Department of Health and Human Services. Naloxone: the opioid reversal drug that saves lives. How healthcare providers and patients can better utilize this life-saving drug. December 2018 [internet publication].Full text

39. Public Health England (UK). Widening the availability of naloxone. 18 February 2019 [internet publication].Full text

40. Babu KM, Brent J, Juurlink DN. Prevention of opioid overdose. N Engl J Med. 2019 Jun 6;380(23):2246-55.Full text  Abstract

41. Sharma V, Simpson SH, Samanani S, et al. Concurrent use of opioids and benzodiazepines/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study. BMJ Open. 2020 Nov 20;10(11):e038692.Full text  Abstract

42. Medicines and Healthcare products Regulatory Agency (UK). Serious and fatal overdose of fentanyl patches. 11 December 2014 [internet publication].Full text

43. US Food and Drug Administration. Accidental exposures to fentanyl patches continue to be deadly to children. 21 July 2021 [internet publication].Full text

44. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): ​notes from the field: geo-temporal trends in fentanyl administration routes among adults reporting use of illegally manufactured fentanyl when assessed for substance-use treatment - 14 U.S. States, 2017-2023. Dec 2024 [internet publication].Full text

45. Halifax JC, Lim L, Ciccarone D, et al. Testing the test strips: laboratory performance of fentanyl test strips. Harm Reduct J. 2024 Jan 18;21(1):14.Full text  Abstract

46. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th rev ed​. Washington: American Psychiatric Association Publishing; 2022.

47. Levengood TW, Yoon GH, Davoust MJ, et al. Supervised injection facilities as harm reduction: a systematic review. Am J Prev Med. 2021 Nov;61(5):738-49.Full text  Abstract

48. Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Full text  Abstract

49. Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Full text

50. Hoffman JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med. 1991 Mar;20(3):246-52. Abstract

51. Armenian P, Vo KT, Barr-Walker J, et al. Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review. Neuropharmacology. 2018 May 15;134(pt a):121-32.Full text  Abstract

52. Abdelal R, Banerjee AR, Carlberg-Racich S, et al. The need for multiple naloxone administrations for opioid overdose reversals: a review of the literature. Subst Abus. 2022;43(1):774-84.Full text  Abstract

53. Royal College of Emergency Medicine. Best pratice guidelines: management of suspected internal drug trafficker (SIDT)​. Dec 2020 [internet publication].Full text

54. Flach PM, Ross SG, Ampanozi G, et al. "Drug mules" as a radiological challenge: sensitivity and specificity in identifying internal cocaine in body packers, body pushers and body stuffers by computed tomography, plain radiography and Lodox. Eur J Radiol. 2012 Oct;81(10):2518-26. Abstract

55. Baril L. ​Body packers, stuffers, and pushers: time bombs in our EDs. FOAMTOX. 2022 Jun 13.Full text

56. Whipple JK, Quebbeman EJ, Lewis KS, et al. Difficulties in diagnosing narcotic overdoses in hospitalized patients. Ann Pharmacother. 1994 Apr;28(4):446-50. Abstract

57. Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Full text  Abstract

58. Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Full text  Abstract

59. Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012 Jul 12;367(2):146-55.Full text  Abstract

60. Mills CA, Flacke JW, Flacke WE, et al. Narcotic reversal in hypercapnic dogs: comparison of naloxone and nalbuphine. Can J Anaesth. 1990 Mar;37(2):238-44. Abstract

61. Mills CA, Flacke JW, Miller JD, et al. Cardiovascular effects of fentanyl reversal by naloxone at varying arterial carbon dioxide tensions in dogs. Anesth Analg. 1988 Aug;67(8):730-6. Abstract

62. Thadani PV. NIDA conference report on cardiopulmonary complications of "crack" cocaine use. Clinical manifestations and pathophysiology. Chest. 1996 Oct;110(4):1072-6. Abstract

63. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1334-49. Abstract

64. Kerr D, Kelly AM, Dietze P, et al. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction. 2009 Dec;104(12):2067-74. Abstract

65. Chou R, Korthuis PT, McCarty D, et al. Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review. Ann Intern Med. 2017 Dec 19;167(12):867-75.Full text  Abstract

66. Dietze P, Jauncey M, Salmon A, et al. Effect of intranasal vs intramuscular naloxone on opioid overdose: a randomized clinical trial. JAMA Netw Open. 2019 Nov 1;2(11):e1914977.Full text  Abstract

67. Sutter ME, Gerona RR, Davis MT, et al. Fatal fentanyl: one pill can kill. Acad Emerg Med. 2017 Jan;24(1):106-13.Full text  Abstract

68. Rogers JS, Rehrer SJ, Hoot NR. Acetylfentanyl: an emerging drug of abuse. J Emerg Med. 2016 Mar;50(3):433-6. Abstract

69. Royal College of Emergency Medicine; National Poisons Information Service. Best practice guideline: guideline for the assessment and management of acute opioid toxicity in adults in the emergency department. Apr 2024 [internet publication].Full text

70. van Dorp E, Yassen A, Sarton E, et al. Naloxone reversal of buprenorphine-induced respiratory depression. Anesthesiology. 2006 Jul;105(1):51-7. Abstract

71. Gal TJ. Naloxone reversal of buprenorphine-induced respiratory depression. Clin Pharmacol Ther. 1989 Jan;45(1):66-71. Abstract

72. Link HM, Jones H, Miller L, et al. Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2020 Aug;2(3):100179. Abstract

73. Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017 Aug;130(2):e81-94.Full text  Abstract

74. The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. J Addict Med. 2020 Mar/Apr;14(2s 1 suppl):1-91.Full text  Abstract

75. Taming the SRU. Packers, stuffers, and pushers. Sep 2022 [internet publication].Full text

76. Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila). 2015 Jan;53(1):5-12. Abstract

77. CorePendium. Body packers, body stuffers. Aug 2024 [internet publication].Full text

78. Juurlink DN. Activated charcoal for acute overdose: a reappraisal. Br J Clin Pharmacol. 2016 Mar;81(3):482-7.Full text  Abstract

79. O'Driscoll BR, Howard LS, Earis J, et al; British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017 Jun;72(suppl 1):ii1-90.Full text  Abstract

80. Purdue Pharma. FDA approves nalmefene HCl injection, 2mg/2mL (1mg/1mL) for the treatment of known or suspected opioid overdose with natural or synthetic opioids. 23 February 2022 [internet publication].Full text

81. Cipriano A, Apseloff G, Kapil RP, et al. Time course of reversal of fentanyl-induced respiratory depression in healthy subjects by intramuscular nalmefene and intramuscular and intranasal naloxone. J Clin Pharmacol. 2025 Feb;65(2):206-16.Full text  Abstract

82. Stolbach AI, Mazer-Amirshahi ME, Nelson LS, et al. American College of Medical Toxicology and the American Academy of Clinical Toxicology position statement: nalmefene should not replace naloxone as the primary opioid antidote at this time. Clin Toxicol (Phila). 2023 Nov;61(11):952-5. Abstract

83. Infante AF, Elmes AT, Gimbar RP, et al. Stronger, longer, better opioid antagonists? Nalmefene is NOT a naloxone replacement. Int J Drug Policy. 2024 Feb;124:104323.Full text  Abstract

84. Green M, Veltri CA, Grundmann O. Nalmefene hydrochloride: potential implications for treating alcohol and opioid use disorder. Subst Abuse Rehabil. 2024;15:43-57.Full text  Abstract

85. Bremer PT, Burke EL, Barrett AC, et al. Investigation of monoclonal antibody CSX-1004 for fentanyl overdose. Nat Commun. 2023 Dec 5;14(1):7700.Full text  Abstract

86. U.S. Department of Health and Human Services. ​How to respond to an opioid overdose. Dec 2022 [internet publication].Full text

87. National Institute for Health and Care Excellence. Drug misuse in over 16s: opioid detoxification. July 2007 [internet publication].Full text

88.  Olfson M, Crystal S, Wall M, et al. Causes of death after nonfatal opioid overdose. JAMA Psychiatry. 2018 Aug 1;75(8):820-7.Full text  Abstract

89. Mechling BM, Ahern N, Palumbo R, et al. Emergency department-initiated interventions for illicit drug overdose: an integrative review of best practices. J Psychosoc Nurs Ment Health Serv. 2023 Jun;61(6):18-24. Abstract

90. U.S. Food and Drug Administration. ​Food and Drug Administration overdose prevention framework. Mar 2025 [internet publication].Full text

91. Langford AV, Lin CC, Bero L, et al. Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations. Med J Aust. 2023 Jul 17;219(2):80-9.Full text  Abstract

92. Livingston CJ, Berenji M, Titus TM, et al. American College of Preventive Medicine: addressing the opioid epidemic through a prevention framework. Am J Prev Med. 2022 Sep;63(3):454-65.Full text  Abstract

93. Jegede O, De Aquino JP, Hsaio C, et al. The impact of high-potency synthetic opioids on pharmacotherapies for opioid use disorder: a scoping review. J Addict Med. 2024 Sep-Oct 01;18(5):499-510. Abstract

94. O'Rourke BP, Hogan TH, Teater J, et al. Initiation of medication for opioid use disorder across a health system: a retrospective analysis of patient characteristics and inpatient outcomes. Drug Alcohol Depend Rep. 2022 Dec;5:100114.Full text  Abstract

95. Centers for Disease Control and Prevention. Overdose prevention: linking people with opioid use disorder to medication treatment. Feb 2025 [internet publication].Full text

96. Armoon B, SoleimanvandiAzar N, Rostami M, et al. Drug type and risk behaviors associated with non-fatal overdose among people who use drugs: a systematic review and meta-analysis. J Addict Dis. 2022 Jan-Mar;40(1):114-25. Abstract